Demographic Moderators of the Relationship Between Adverse Childhood Experiences and Cigarette Smoking

Background: Research suggests that there is a dose-response relationship between Adverse Childhood Experiences (ACEs) and cigarette smoking, such that as ACE score increases, so do the odds of smoking behavior, but little is known about what factors moderate this relationship. Objectives: The goal of this study was to examine demographic characteristics as potential moderators of relationship between ACE score and cigarette smoking. Methods: A secondary data analysis was conducted using the 2013 California Behavioral Risk Factor Surveillance System data. The sample included 2,604 U.S. adults (54.8% female; Age: M = 53.3, SD = 8.10). We used multinomial logistic regression to test sex, race, income, and education as moderators of the relationship between ACE score and smoking. Results: ACEs were not significantly associated with smoking behavior. No interactions between ACE score and sex, race, education, or income significantly predicted smoking outcomes. Sex, race, education, and income were significantly and independently associated with smoking outcomes. Men, individuals with lower income and education, and certain ethnic/racial groups reported greater odds of smoking. Conclusions/Importance: Results suggest that there may not be a relationship between ACEs and smoking later in life. Additionally, the relationship between ACEs and smoking in adulthood may not depend on basic demographic features. Knowing which populations are more vulnerable to smoking can help clinicians better assess and tailor interventions to meet the needs of their patients by using culturally sensitive interventions and obtaining resources to help improve treatment access, motivation, and success.